Effect of Investment in Malaria Control on Child Mortality in Sub-Saharan Africa in 2002–2008

Abstract

BackgroundAround 8.8 million children under-five die each year, mostly due to infectious diseases, including malaria that accounts for 16% of deaths in Africa, but the impact of international financing of malaria control on under-five mortality in sub-Saharan Africa has not been examined.Methods and FindingsWe combined multiple data sources and used panel data regression analysis to study the relationship among investment, service delivery/intervention coverage, and impact on child health by observing changes in 34 sub-Saharan African countries over 2002–2008. We used Lives Saved Tool to estimate the number of lives saved from coverage increase of insecticide-treated nets (ITNs)/indoor residual spraying (IRS). As an indicator of outcome, we also used under-five mortality rate. Global Fund investments comprised more than 70% of the Official Development Assistance (ODA) for malaria control in 34 countries. Each $1 million ODA for malaria enabled distribution of 50,478 ITNs [95%CI: 37,774–63,182] in the disbursement year. 1,000 additional ITNs distributed saved 0.625 lives [95%CI: 0.369–0.881]. Cumulatively Global Fund investments that increased ITN/IRS coverage in 2002–2008 prevented an estimated 240,000 deaths. Countries with higher malaria burden received less ODA disbursement per person-at-risk compared to lower-burden countries ($3.90 vs. $7.05). Increased ITN/IRS coverage in high-burden countries led to 3,575 lives saved per 1 million children, as compared with 914 lives in lower-burden countries. Impact of ITN/IRS coverage on under-five mortality was significant among major child health interventions such as immunisation showing that 10% increase in households with ITN/IRS would reduce 1.5 [95%CI: 0.3–2.8] child deaths per 1000 live births.ConclusionsAlong with other key child survival interventions, increased ITNs/IRS coverage has significantly contributed to child mortality reduction since 2002. ITN/IRS scale-up can be more efficiently prioritized to countries where malaria is a major cause of child deaths to save greater number of lives with available resources.

Changes in government spending on healthcare and population mortality in the European union, 1995–2010: a cross-sectional ecological study

“…25,26 Decreases in government healthcare spending (as a percentage of total government expenditure) were significantly associated with decreased healthcare spending per capita (measured in purchasing power parity; R 312.9, p < 0.0001, CI 211.2 to 414.6). Decreased healthcare spending per capita was associated with significantly decreased physician availability (R 0.0002, p ¼ 0.0001, CI 0.0001 -0.0003).…”

Cross-Border Malaria: A Major Obstacle for Malaria Elimination

“…This reduction has most likely been a result of the combined effects of economic development in endemic countries, urbanization and unprecedented financial support for malaria interventions from donors and the associated scaling up of malaria interventions. In sub-Saharan Africa, there was a 66-fold increase in the amount of official development assistance disbursed for malaria control, from $9.8 million in 2002 to $651.7 million in 2008 (Akachi and Atun, 2011). Major funders include Roll Back Malaria, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President's Malaria Initiative and the World Bank's International Development Association (Feachem et al, 2010a) and funding from the Bill and Melinda Gates Foundation has been transformational in driving malaria elimination research.…”

Novel serologic biomarkers provide accurate estimates of recent Plasmodium falciparum exposure for individuals and communities

“…Effectively using limited resources for malaria control or elimination and evaluating interventions require accurate measurements of the risk of being infected with Pf (2-15). To reflect the rate at which individuals are infected with Pf in a useful way, metrics used to estimate exposure in a community need to account for dynamic changes over space and time, especially in response to control interventions (16)(17)(18).A variety of metrics can be used to estimate Pf exposure, but tools that are more precise and low cost are needed for population surveillance. Existing metrics have varying intrinsic levels of precision and accuracy and are subject to a variety of extrinsic factors, such as cost, time, and availability of trained personnel (19).…”

“…Effectively using limited resources for malaria control or elimination and evaluating interventions require accurate measurements of the risk of being infected with Pf (2-15). To reflect the rate at which individuals are infected with Pf in a useful way, metrics used to estimate exposure in a community need to account for dynamic changes over space and time, especially in response to control interventions (16)(17)(18).…”